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Most obese teens accurately perceive themselves as overweight and intend todo something about it, according to a recent Delaware study.
"This group would be amenable to suggestions made by a health careprovider," concludes lead author Heather Bittner Fagan, MD, a familyphysician at Christiana Care Health Systems in Wilmington, Del. "Theseindividuals would seem likely to take advantage of opportunities to modifyweight, for example, nutrition referral and walking programs."
While recent studies have shown that parents often do not perceive whentheir children are overweight (DOC News, October 2004), Bittner Faganfound 81.8% of obese adolescents recognized that they weigh too much. Inaddition, 75.3% of this group intended to lose weight and 66% reported havingtaken some action—either diet or exercise—to lose weight.
Presented during poster sessions at the American Academy of FamilyPhysicians (AAFP) Scientific Assembly in October, the study used a 2003self-reported survey of high school students in Delaware. The Youth RiskBehavior Surveillance System survey was created by the Division of Adolescentand School Health at the Centers for Disease Control and Prevention (CDC). Itasks 106 questions about risk behavior including drug use, sex, personal risk(e.g., weapons), and nutrition and physical activity.
The sample in Bittner Fagan's study were obese adolescents, defined asthose 12 to 18 years old with a body mass index (BMI) greater than the95th percentile for age and gender. BMI was calculated from thestudents' self-reported height and weight. In a general population of 2,728adolescents, 398 (14.6%) were identified as obese.
Earlier research has shown that awareness of a problem is considered to bethe first step in behavior change, Bittner Fagan writes. Understanding theprocess of behavior change regarding obesity in adolescents will assistefforts to promote healthy behavior in this group and help physicians identifyhow to effectively target their efforts, she says.
Intention to modify body weight was defined by the question: "Whatare you trying to do about your weight?" Those who answered, "Loseweight," were considered to have an intention to do so.
Targeted action included increased physical activity and diet changes.Subjects who answered "yes" to either one of two questions wereconsidered to be taking targeted action to reduce their weight. The firstquestion asked: "In the past 30 days did you exercise to lose weight orto keep from gaining weight?" The second question asked: "Duringthe past 30 days did you eat less food, fewer calories, or foods low in fat tolose weight or keep from gaining weight?"
Bittner Fagan notes that although most obese teens say they are takingaction to lose weight, "the degree of change may not be what iscurrently considered sufficient in terms of intensity of physical activity orcontent of diet," which her study did notaddress.
Also, the study found a significant minority of obese teens, about 18%, whodo not perceive themselves as overweight while about 25% do not intend tochange their weight, and 17% are taking no action to lose weight.
Bittner Fagan suggests those who are unaware of their weight problem mightbenefit if a physician calculates and graphs BMI, showing the individual wherehe or she falls among peers. For those with no intention of addressing weightloss, physicians could provide education about the negative effects ofoverweight/obesity. Clinicians could advise obese teens who are not takingweight modification measures to increase their physical activity by decreasingtelevision time, or to decrease portion size and increase intake of fruits andvegetables. 
Footnotes
More information on the Youth Risk Behavior Surveillance System can befound on the CDC web site atwww.cdc.gov/HealthyYouth.
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